Risk Factors For Gestational Diabetes Mellitus Research Articles

Factors Associated With Gestational Diabetes Mellitus: A Cross-Sectional Study.

IntroductionThe absence of tolerance in the levels of carbohydrates at the onset or at the time of pregnancy amongst females is known as gestational diabetes mellitus (GDM). This study is designed to determine the frequency of GDM and factors responsible for GDM to assess the actual magnitude of the outcome. Furthermore, it allows for developing strategies to minimize morbidities and improve the pregnancy outcome by early diagnosis and timely management, which can help reduce the frequency of GDM. The aim of the study was to determine the frequency of GDM and the factors responsible for GDM.MethodsThis was a cross-sectional study conducted in the Department of Obstetrics & Gynaecology Unit 2, Civil Hospital Karachi from the period starting from March 1, 2017, and ending on August 31, 2017, in order to determine the prevalence and associated risk factors of GDM. The study was carried out on 674 pregnant women. A total of 185 consecutive booked cases between the ages of 20 and 40 years, with parity 1 or more with gestational age greater than 24 weeks, were included in the study. Fasting plasma glucose levels 5.1-6.9 mmol/L (92-125mg/dl) and two hours plasma glucose levels of 8.5-11.0 mmol/L (153-199mg/dl) were set up as cut-off levels. GDM and factors were labeled on the basis of cut-off levels. Factors responsible for GDM included high maternal age when the age of the women was greater than 35 years and grand multiparity when women having a number of children greater than five, that is, women who have given birth five or more times. The collection forms were completed in the postpartum period. All information was obtained through the patient's clinical record and prenatal card. Initially, all variables were analyzed descriptively. To see the association of the groups, the chi-squared test (χ2 test) or Fisher's exact test was used. The level of significance used for the tests was 5%.ResultsThe prevalence of gestational diabetes was 9.73% (95% CI: 8.53-12.64). The average age of the patients was 28.99 ± 4.34 years. The average pre-gestational BMI was 25.44 ± 2.74. Out of 185 women, 127 (68.65%) were less than or equal to 30 years of age. The average pre-gestational BMI was 25.44 ± 2.74, and average gestational age was 28.99 ± 2.34 years, respectively. A total of 161 (87.03%) of the women had a family monthly income of more than 10,000 PKR. There were 61 (32.97%) primiparous, 97 (52.43%) multiparous, and 27 (14.59%) grand multiparous women. Most of the women were illiterate numbering 36 (19.46%) or primary educated, numbering 30 (16.22%), and secondary educated or higher numbering 6 (3.24%). High maternal age (>30 years), high parity (>3), previous history of GDM, and family history of GDM were the significant factors of GDM.ConclusionThe results of our study showed that the prevalence of gestational diabetes was 9.73% (95% CI: 8.53-12.64). Therefore, this study also showed that developing GDM was directly related to the following factors; such as the history of GDM in previous pregnancies with advanced maternal age, increased parity, and any medical history including a family history of GDM, along with the level of education of women. Hence, early detection and intervention are important because it improves pregnancy outcome.

The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome: What should we care.

The influencing factors of gestational diabetes mellitus (GDM) in the polycystic ovary syndrome (PCOS) patients remain unclear, we aimed to investigate the risk factors of GDM in patients with PCOS, to provide reliable evidence for the prevention and treatment of GDM in PCOS patients.PCOS patients treated in our hospital from January 1, 2019 to October 31, 2020 were included. The personal and clinical treatment details of GDM and no GDM patients were analyzed. Logistic regressions were performed to analyze the factors influencing the occurrence of GDM.A total of 196 PCOS patients were included, the incidence of GDM in patients with PCOS was 23.98%. There were significant differences in the age, body mass index, insulin resistance index, fasting insulin, testosterone, androstenedione, and sex hormone-binding protein between GDM and no GDM patients with PCOS (all P < .05), and no significant differences in the family history of GDM, the history of adverse pregnancy, and multiple pregnancies were found (all P > .05). Age ≥30 years (odds ratio (OR) 2.418, 95% confidence interval (CI) 1.181–3.784), body mass index ≥24 kg/m2 (OR 1.973, 95%CI 1.266–3.121), insulin resistance index ≥22.69 (OR 2.491, 95%CI 1.193–4.043), fasting insulin ≥22.71 mIU/L (OR 2.508, 95%CI 1.166–5.057), testosterone ≥2.85 nmol/L (OR 1.821, 95%CI 1.104–2.762), androstenedione ≥6.63 nmol/L (OR 1.954, 95%CI 1.262–2.844), sex hormone-binding protein <64.22 nmol/L (OR 1.497, 95%CI 1.028–2.016) were the independent risk factors of GDM in patients with PCOS (all P < .05). The incidence of preeclampsia, premature delivery, premature rupture of membranes, polyhydramnios, and postpartum hemorrhage in the GDM group was significantly higher than that of the no-GDM group (all P < .05). There was no significant difference in the incidence of oligohydramnios between the 2 groups (P = .057).The incidence of GDM in PCOS patients is high, and the measures targeted at the risk factors are needed to reduce the occurrence of GDM in patients with PCOS.

Fasting plasma glucose in the first trimester is related to gestational diabetes mellitus and adverse pregnancy outcomes

PurposeTo investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population.MethodsWe used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities.ResultsThe mean first-trimester FPG was 4.62 ± 0.42 mmol/L. A total of 6998 (14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130 (2.33%), 20,426 (42.16%), 7237 (14.94%), 2386 (4.93%), and 1865 (3.85%), respectively. 4233 (8.74%) of the newborns were LGA, and the number of macrosomia was 2272 (4.69%), LBW was 1701 (3.51%) and 5084 (10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P < 0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section, and LGA (all OR > 1, all P < 0.05), furthermore, the risks of GDM, primary cesarean section, and LGA was increasing with first-trimester FPG as early as it was at 4.19–4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19–4.63, 4.63–5.11 and 5.11–7.0 mmol/L were 1.137, 1.592, and 4.031, respectively, all P < 0.05) increased as early as first-trimester FPG was at 4.19–4.63 mmol/L, and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11–7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11–7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63–5.11 and 5.11–7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P < 0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95% CI: 0.763~0.779) and 0.770(95% CI:0.758~0.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction.ConclusionsFPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.

Older Underweight Pregnant Women Beat Young Overweight/Obese Ones on Incidence of Gestational Diabetes.

ObjectiveThis study aimed to compare the incidence of gestational diabetes mellitus (GDM) in older underweight pregnant women vs young overweight/obese ones.MethodsA multiracial retrospective-cohort study was conducted in five hospitals of Shanghai on 7,485 women who had been pregnant during 2018–2020. Incidence of GDM was equal to the proportion of GDM cases in the total number of cases observed in the same period. Comparison of GDM incidence of older underweight pregnant women and young overweight/obese ones was done with χ2 tests. ORs and 95% CIs for GDM were estimated using univariate and multivariate logistic regression across gestation age and prepregnancy BMI.ResultsAdvanced age (OR 1.09, 95% CI 1.072–1.11; P=0) and higher BMI (OR 1.57, 95% CI 1.112–2.212; P=0.01) were found to be risk factors of GDM. The incidence of 13.33% of older underweight pregnant women (age ≥35years, BMI <18.5 kg/m2) developing GDM was lower than that of young overweight/obese ones (age ≤24 years, BMI ≥24 kg/m2). For those aged ≥35years, it is advised that BMI be kept to <18.5 kg/m2. For those aged ≤24 years, BMI control should not exceed 24 kg/m2.ConclusionOlder underweight (age≥35years, BMI <18.5 kg/m2) pregnant women beat young overweight/obese ones (age ≤24 years, BMI ≥24 kg/m2) on incidence of GDM. Factors influencing obesity/overweight in GDM were high maternal age, though being young is a promising protective factor for GDM and tolerance of BMI is promoted, but should be limited to certain ranges. Being older increased the chances of developing GDM, but those with lower BMI still had lower GDM incidence than younger pregnant women.

A Glimpse at the Size of the Fetal Liver-Is It Connected with the Evolution of Gestational Diabetes?

Gestational diabetes mellitus (GDM) is defined as an impairment of glucose tolerance, manifested by hyperglycemia, which occurs at any stage of pregnancy. GDM is more common in the third trimester of pregnancy and usually disappears after birth. It was hypothesized that the glycemic status of the mother can modulate liver development and growth early during the pregnancy. The simplest modality to monitor the evolution of GDM employs noninvasive techniques. In this category, routinely obstetrical ultrasound (OUS) examinations (simple or 2D/3D) can be employed for specific fetal measurements, such as fetal liver length (FLL) or volume (FLV). FLL and FLV may emerge as possible predictors of GDM as they positively relate to the maternal glycated hemoglobin (HbA1c) levels and to the results of the oral glucose tolerance test. The aim of this review is to offer insight into the relationship between GDM and fetal nutritional status. Risk factors for GDM and the short- and long-term outcomes of GDM pregnancies are also discussed, as well as the significance of different dietary patterns. Moreover, the review aims to fill one gap in the literature, investigating whether fetal liver growth can be used as a predictor of GDM evolution. To conclude, although studies pointed out a connection between fetal indices and GDM as useful tools in the early detection of GDM (before 23 weeks of gestation), additional research is needed to properly manage GDM and offspring health.

Backpropagation Neural Network Algorithm-Based Color Doppler Ultrasound Detection of Gestational Diabetes Mellitus and Perinatal Outcomes

In this work, the related risk factors and perinatal outcomes of pregnant women with gestational diabetes mellitus (GDM) were analyzed based on color Doppler ultrasound (CDU) diagnosis. Backpropagation (BP) algorithm-based CDU imaging algorithm (BPC) was constructed in this study and applied in CDU images of 80 pregnant women with GDM. Besides, amplitude and phase estimation (APES) and low-complexity adaptive beam (LCA) algorithms were introduced for comparison with BPC in turn. It was found that Dice similarity coefficient (96.44%), sensitivity (95.45%), and specificity (91.56%) of BPC were greater than those of APES (83.97%, 85.84%, 78.45%) and LCA (84.74%, 86.29%, 82.35%), while its running time (6.44 ± 1.39 s) was shorter than that of APES (11.87 ± 2.41 s) and LCA (13.76 ± 1.54 s) ( P &lt; 0.05 ). Pregnant women in the experimental group (group B) were older than those in the control group (group A) ( P &lt; 0.05 ). The pulsatility index (PI) and renal artery resistance index (RI) of fetuses in group B (0.95 ± 0.15) were higher than those of group A (0.57 ± 0.24) ( P &lt; 0.05 ). In addition, pregnancy age, family history of hypertension, and abortion history were positively correlated with GDM ( P &lt; 0.05 ). In conclusion, BPC could not only improve diagnosis accuracy in fetuses’ CDU images but also shorten calculation time. Pregnancy age, family history of hypertension, and abortion history were the related risk factors for GDM in pregnant women.

Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories

Whether categories of family history of diabetes can act as independent risk factors for gestational diabetes mellitus (GDM-1, -2) has not yet been established, and neither has it been established how categories of body mass index (BMI) affect these relationships. A group of 912 women without chronic diseases, recruited in the first trimester, was investigated: 125 (13.7%) women developed GDM-1 (treated with diet); 21 (2.3%) women developed GDM-2 (treated with insulin); and a control group consisted of 766 non-diabetic women. A multiple logistic regression was used to evaluate adjusted odds ratios (AOR (95% confidence intervals)) of GDM-1 and GDM-2 for declared diabetes in the parents or grandparents (separately). These relationships were investigated in the whole cohort and subgroups of pre-pregnancy BMI. (1) Some categories of the family history were independent risk factors of GDM-1 or GDM-2. Compared to ‘absence of diabetes in the family’, women with diabetes in the father had a 3.68-fold increase in GDM-1 risk (AOR-b = 3.68 (2.23–6.07)), and women with diabetes in the mother had a 2.13-fold increase in GDM-1 risk (AOR-b = 2.13 (1.1–4.14)) and a 4.73-fold increase in GDM-2 risk (AOR-b = 4.73 (1.26–17.77)). Women with diabetes in the grandmother had a 2.34-fold increase in GDM-1 risk (AOR-b = 2.34 (1.29–4.24)). (2) The cumulative assessment of diabetes in the parents and/or grandparents was not related to the intensification of the risk of GDM, except for the increased risk of GDM-1 for diabetes in both mother and grandmothers simultaneously (AOR-b = 8.80 (1.16–66.57)), however, this group was very small. (3) The analyses in the subgroups of BMI categories showed that diabetes in the father was also an independent risk factor of GDM in the subgroup of pregnant women with normal BMI. In the subgroups of overweight and/or obesity, the risk of GDM for paternal and maternal diabetes was approximately twice as high as compared to the results of pregnant women with normal BMIs. Additionally, apart from the maternal influence of diabetes, the results suggest a significant influence of diabetes in the father on the risk of GDM, even (interestingly) in lean pregnant women.

Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control

BackgroundStudies linking periodontal disease (PD) and gestational diabetes mellitus (GDM) are not consistent. Our main objective is to evaluate the possible association between PD and GDM. We also analysed the risk factors for GDM in our sample. Methods180 pregnant women participated, 90 with GDM and 90 controls, from Valencia's Hospital La Fe. A questionnaire was completed and a periodontal examination was performed, assessing the following parameters: number of teeth, plaque and bleeding on probing indices, probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to the criteria of CDC-AAP. ResultsThe GDM group had a higher mean value of PD (p = .001) and CAL (p = .028). Of the patients with GDM, 74.4% had gingival inflammation compared to 57.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < .05). Maternal age, educational level and periodontitis are independent risk factors for GDM (OR = 1.16, 95% CI 1.07 to 1.25, p < .001), (OR = .37, 95% CI .19 to .72, p < .005) and (OR = 2.79, 95% CI 1.40 to 5.59, p < .005) respectively. ConclusionsThe results suggest that pregnant women with gestational diabetes have more associated periodontal disease than those without gestational diabetes. In our sample, the risk for GDM can be estimated from periodontitis, age, and educational level.

Distinct Serum Metabolic Profiles in Early Pregnancy Characterise Gestational Diabetes Mellitus Incidence in High-Risk Women

ObjectivesThis study aimed to investigate and characterise the metabolic profiles of gestational diabetes mellitus (GDM) in white European (WE) and British Pakistani (BP) women with and without GDM. Methods146 serum metabolites quantified by nuclear magnetic resonance, from 2668 WEs and 2671 BP pregnant women ≤28 weeks’ gestation from the Born in Bradford cohort were analysed. Partial least squares discriminatory analyses (PLSDA) and sparse PLSDA (sPLSDA) were used to investigate the ethnic-specific metabolite signatures of future incidence of GDM. Metabolite features driven by pre-pregnancy weight status and known GDM risk factors (age, parity, multiple pregnancies and smoking status) were also explored. ResultsModels explained 60% of variance between future GDM cases/non-cases in WE mothers but only 35% in BPs, after adjusting for BMI, age, parity, smoking, and non-singleton pregnancies. Across both ethnic groups, 8 metabolites associated with future GDM status. When ethnic groups were investigated independently, 7 additional metabolites associated with future GDM in WEs were identified, while no additional associations were observed in BPs. Further stratification by BMI (healthy vs overweight/obese) uncovered a metabolic profile (characterised by fatty acids and glycolytic metabolites) unique to normal-weight BP women who later developed GDM. No difference was observed between the metabolic profiles of overweight/obese women, irrespective of ethnicity. ConclusionsIn early pregnancy, the metabolomes of future GDM cases and non-cases are distinct and differ by ethnicity. While the metabolic profiles of overweight women are largely similar in WE and BPs, a unique metabolic profile was observed in healthy weight BP women who went on to develop GDM and offers insight into the early metabolomic perturbations that precede GDM development in this high-risk (but healthy) population. Further exploration regarding the interaction between genetics and lifestyle on modifying metabolic profiles associated with GDM risk will help inform ethnically appropriate nutrition strategies. Funding SourcesHF is supported by a doctoral scholarship from the University of Leeds.

487-P: Exploring the Research Experiences of American Indian Mother/Daughter Dyads and Site Coordinators after a GDM Risk Reduction and Preconception Counseling Randomized Controlled Trial

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and contributes to increased risk for T2D in both the mother and offspring. American Indians are at higher risk of GDM and subsequent diagnosis of T2D than non-Hispanic white women. This project examined the experiences of American Indian mother-daughter (M-D) dyads as participants and the site coordinators who facilitated a GDM risk reduction and preconception counseling randomized controlled trial (RCT) to evaluate Stopping GDM (SGDM). The SGDM RCT included 4 visits over 9 months which dyads attended together but completed SGDM intervention (video and eBook) and questionnaires separately. SGDM content included GDM risk reduction (e.g., healthy nutrition), GDM risk awareness/health beliefs, preconception counseling, reproductive health communication, and family planning. For this study, dyads (n=22 dyads) were recruited from three of the five study sites and site coordinators from all sites participated (n=6). Mothers, daughters, and site coordinators were in separate focus groups. Focus groups were facilitated by trained qualitative researchers, conducted/recorded remotely using Zoom, transcribed verbatim, and analyzed using qualitative content analysis and Atlas.ti. Themes include: 1) SGDM provided valuable quality time and conversation about GDM and reproductive health among dyads; 2) GDM risk factors and risk reduction was largely new information for most dyads; 3) all sites experienced challenges to study engagement and recruitment; 4) recommendations for study improvement: personalized recruitment that is clinic-based and mother-focused; remote/asynchronous study visits; and significantly shorter content. These findings will be used to inform revisions of SGDM to improve the program and for a broader, more inclusive version of the program for other at-risk females. Disclosure S. A. Stotz: None. A. F. Fischl: None. M. A. Terry: None. H. Garrow: None. N. O’banion: None. L. Chalmers: None. K. R. Moore: None. D. Charron-prochownik: None. Funding National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)

Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy

The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy. We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p < 0.05) were included in multivariable analysis. A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p < 0.001). In multivariable analysis, an elevated 1-hour GCT (adjusted odds ratio [aOR]: 4.54, 95% confidence interval [CI]: 3.02-6.81), first-trimester BMI ≥30 kg/m2 in the index pregnancy (aOR: 3.10, 95% CI: 2.03-4.71), Asian race (aOR: 2.96, 95% CI: 1.70-5.12), Hispanic ethnicity (aOR: 2.11, 95% CI: 1.12-4.00), and increasing age (aOR: 1.07, 95% CI: 1.02-1.12) were significantly associated with an increased risk of GDM in the subsequent pregnancy. An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy. · An abnormal 1 hour GCT in an index pregnancy is associated with GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT may be an independent risk factor for GDM in a subsequent pregnancy.. · An abnormal 1 hour GCT is associated with a 4 fold increased risk of GDM in a subsequent pregnancy..

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

IntroductionObstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR). MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5h−1. ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2±6.0 vs. 1.9±2.7h−1, p=.069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p=.232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation<90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index. ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.

Association of Gestational Diabetes Mellitus with Adverse Pregnancy Outcomes and Its Interaction with Maternal Age in Chinese Urban Women.

Background The prevalence of gestational diabetes mellitus (GDM) has been dramatically increasing worldwide. The aims of this study were to examine associations of GDM with pregnancy outcomes in Chinese urban women and to evaluate the interaction between GDM and other major risk factors for the risk of adverse pregnancy outcomes. Methods A retrospective analysis included 8844 women who delivered live singletons at ≥28 weeks of gestation between June 2012 and March 2013 among Chinese urban women. Structured questionnaires were used to collect information on demographic characteristics, lifestyle behavior, medical history, and pregnancy outcomes. The diagnosis of GDM was made between 24 and 28 gestational weeks according to the International Association of Diabetes and Pregnancy Study Groups criteria. Logistic regression models were used to assess the association of GDM with pregnancy outcomes and to examine the interaction between GDM and other major risk factors including maternal age, prepregnancy body mass index, and gestational weight gain for the risk of pregnancy outcomes. Results 13.9% of women were diagnosed with GDM. We found that GDM was associated with higher risk of cesarean delivery (odds ratio (OR) = 1.69, 95% CI (confidence interval): 1.48-1.92), preterm birth (OR = 1.32, 95% CI: 1.07-1.64), macrosomia (OR = 1.69, 95% CI: 1.34-2.13), and large for gestational age (LGA, OR = 1.43, 95% CI: 1.18-1.73) after adjustment for potential confounders. We also observed the interaction between GDM and maternal age for the risk of cesarean delivery (P for interaction = 0.025), and the OR of GDM for cesarean delivery was 1.71 (95% CI: 1.49-1.97) among women aged less than 35 years. Conclusions GDM was associated with an increased risk of cesarean delivery, preterm birth, macrosomia, and LGA in Chinese urban women, and there was an interaction between GDM and maternal age for the risk of cesarean delivery.

Association of lipoprotein a in early pregnancy with gestational diabetes mellitus: a prospective cohort study

Objective: To investigate the association of lipoprotein a (Lpa) in early pregnancy with gestational diabetes mellitus (GDM) risk. Methods: A total of 445 pregnant women in 12-14 gestational weeks from "Maternal Key Nutritional Factors and Offspring's Atopic Dermatitis" cohort were included in this study. The demographic characteristics of participants were collected by using questionnaires, and the fasting glucose and lipids levels in early pregnancy were measured. The results of oral glucose tolerance test (OGTT) between 24-28 gestational weeks were recorded. Multivariate logistic regression model was applied to analyze the association of Lpa with GDM by calculating the OR and 95%CI after adjustment for covariates. Results: The incidence number of GDM was 78 (17.5%). The Lpa level in pregnant women with GDM was significantly higher than that in pregnant women without GDM [105.5 (92.0, 122.0) vs. 97.0 (87.0, 109.0) mg/L], P<0.05. Lpa was significantly associated with GDM risk [OR (95%CI) =1.21(1.08-1.36) per 10 mg/L], P<0.05. The association was still significant after adjustment for covariates including age, gestational weeks et al, the adjusted OR was 1.14 (95%CI: 1.01-1.30), P=0.03. Conclusions: The elevation of Lpa in early pregnancy is one of risk factor for GDM. Maintaining normal Lpa level during early pregnancy can benefit early prevention of GDM and offspring health.

Comparison of ultrasound with biomarkers to identify large-for-gestational age in women screened for gestational diabetes mellitus

Objective Large-for-gestational-age (LGA) is associated with both fetal and maternal complications. One of the few modifiable risk factors for LGA is Gestational Diabetes Mellitus (GDM); for this reason, fetal growth is usually monitored by ultrasound in the third trimester. This prospective study compared a panel of ten established biomarkers measured at the time of selective screening for GDM at 26–28 weeks gestation with the ultrasound prediction of LGA. Method Women were recruited using convenience sampling and consented at the first antenatal visit. Women with maternal risk factors for GDM attended for the one-step 75 g oral glucose tolerance test. An additional blood sample was taken for biomarker measurement. GDM was diagnosed according to the 2013 World Health Organization (WHO) criteria. Fetal biometry, including the abdominal circumference (AC) and the fetal abdominal subcutaneous tissue (FAST) thickness, were measured at 37 weeks gestation. Results Of the 195 women included, 105 (53.8%) had GDM. Of the 195 babies, 36 (18.5%) were LGA. Whether the woman had GDM or not, fetal biometry was strongly predictive of LGA but none of the following biomarkers measured at 26–28 weeks gestation alone or in combination were predictive: c-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide-1 (GLP-1), glucagon, insulin, leptin, plasminogen activator inhibitor-1, resistin and visfatin. Conclusions In women diagnosed with GDM, surveillance of fetal growth to identify LGA by ultrasound should continue in the third trimester. None of the ten established maternal biomarkers measured at the time of the OGTT was as strongly predictive of LGA as ultrasound.

A case-control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history.

BackgroundGestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns.ObjectiveTo evaluate the rate and investigate the risk factors for developing GDM.Materials and MethodsIn this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups.Results Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) 90 qmg/dl group (p 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p 0.01).ConclusionBoth patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier.

Evaluation of VDR gene FokI polymorphism and serum vitamin D level in gestational diabetes mellitus (Egyptian case-control study)

Gestational diabetes mellitus (GDM) affects 1%–14% of all gestations. The importance of GDM stems from its relationship with adverse pregnancy outcomes. This study aimed to evaluate the correlations of vitamin D receptor (VDR) gene FokI polymorphisms with GDM in the Egyptian population. In a comparative case-control study, 196 pregnant women were divided into GDM and control groups (98 each group). The VDR gene FokI genotypes were determined in pregnant women under investigation. Both groups show no statistically significant difference for serum 25-hydroxy vitamin D (25-OHD) level, maternal age, gestational age in weeks, parity, and blood pressure. On the other hand, past miscarriage history, body mass index (BMI), glycated hemoglobin (HbA1c), and homeostasis model assessment for insulin resistance (HOMA-IR) were significantly higher in the GDM group vs. the control group. Genotype CC was found as a risk factor for GDM due to the increased odds ratio (OR) 3.78 [(1.57–8.62)] (P = 0.002). The risk of GDM decreased significantly with the dominant homozygous allele T in the tested polymorphism TT + TC vs. CC (OR = 0.32, 95% CI = 0.15–0.68 and p-value = 0.002). Genotype CC is associated with vitamin D deficiency [OR 14.4 (4.03–51.5), P = 0.001], and C allele is also associated with vitamin D deficiency [OR 2.35 (1.28–4.30), P = 0.005)]. There was a relationship between VDR gene FokI polymorphism and the development of GDM. Besides, a possible association exists between genotype CC and C allele and vitamin D deficiency.

Risk factors associated with gestational diabetes mellitus: a retrospective case-control study

ObjectivesThe prevalence of gestational diabetes mellitus (GDM) has increased year-after-year globally, especially in low-income and developing countries. This study aims to identify the prevalence of GDM, the risk factors, and the effect on pregnancy outcome based on a retrospective case-control study.MethodsTwo hundred ninety-three parturients with GDM who delivered in a general hospital in Fujian province and met the inclusion criteria were selected as the case group from January to June 2018. Two hundred ninety-three parturients without GDM who delivered in the same period served as the control group. Risk factors for GDM were determined by univariate and binary logistic regression analysis. The prevalence of pregnancy outcomes was determined by a chi-square test.ResultsThe prevalence of GDM was 15.69%. The percentages of 1, 2, and 3 abnormal OGTT values were 55.6%, 30.7%, and 13.7%, respectively. Gravidas with GDM have a higher risk of macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and gestational hypertension than gravidas without GDM (p < 0.05). Analysis of the factors influencing the development of GDM was advanced age, married, parents with a history of diabetes, gestational hypertension, and number of abortions.ConclusionsThe prevalence of GDM was 15.69% in this geographic region, and > 50% of the patients had one abnormal OGTT value. The risk factors for GDM were advanced age, parents with diabetes, gestational hypertension, and the number of abortions. Pregnancy outcomes of the two groups of patients were different with respect to macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and hypertensive disorders of pregnancy.

First pregnancy risk factors and future gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) affect about 17% of all pregnancies and is associated with significant short- and long-term health consequences for the mother and her offspring. Early diagnosis and prompt interventions may reduce these adverse outcomes. We aimed to identify first pregnancy characteristics as risk factors for GDM in subsequent pregnancy. A population-based nested case-control study was conducted in a large tertiary hospital. The study population included all women with two singleton consecutive pregnancies and deliveries, without GDM in the first pregnancy. Characteristics and complications of the first pregnancy were compared among cases and controls. A multivariable logistic regression model was used to study the association between pregnancy complications (in the first pregnancy) and GDM in the subsequent pregnancy, while adjusting for confounding variables. A total of 38,750 women were included in the study, of them 1.9% (n = 728) had GDM in their second pregnancy. Mothers with GDM in their second pregnancy were more likely to have the following first pregnancy complications: hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia. Results remained significant after adjustment for maternal age and inter-pregnancy interval. Having either one of the complications increased the risk for GDM by 2.33 (adjusted OR = 2.33; 95% CI 1.93-2.82) while a combination of two complications increased GDM risk by 5.38 (adjusted OR = 5.38; 95% CI 2.85-10.17). First pregnancy without GDM complicated by hypertensive disorders, perinatal mortality, maternal obesity and fetal macrosomia was associated with an increased risk for GDM in the subsequent pregnancy. Women with these complications may benefit from early detection of GDM in their subsequent pregnancy.

Glycaemic Variability and Risk Factors of Pregnant Women with and without Gestational Diabetes Mellitus Measured by Continuous Glucose Monitoring.

Background: The aim of the study was to compare the continuous glucose monitoring (CGM)-determined glycaemic variability (GV) of pregnant women with gestational diabetes mellitus (GDM) and without GDM (CG; control group). The secondary aim was to evaluate the association between risk factors of diabetes in pregnancy and parameters of glyceamic control. Methods: Demographic, biometric and biochemical parameters were obtained for pregnant women (20–38 years old) who after an oral glucose tolerance test were examined by 7-day continuous glucose monitoring using a iPro®2 Professional CGM. Results: The differences in GV between women with GDM and CG compared by total area under glucose curve (total AUC, (mmol·day/L) was statistically significant (p = 0.006). Other parameters of glycaemic control such as mean glucose, standard deviation, coefficient of variation, J-index, % time-above target range 7.8 mmol/L (%TAR), % time-in range 3.5–7.8 mmol/L (%TIR), time-below target range 3.5 mmol/L (%TBR), glycated haemoglobin were not significantly different in the study groups. Risk factors (a family history of diabetes, pre-pregnancy BMI, higher weight gain and age) correlated with parameters of glycaemic control. Conclusions: We found a significant difference in GV of women with and without GDM by total AUC determined from CGM. TIR metrics were close to significance. Our work points at an increased GV in relation to the risk factors of GDM. Pregnant women with risk factors have higher probability of severe GV with its consequences on maternal and fetal health state.